Who Gets Tested For Coronavirus, How To Properly Use Masks, & Other Health Questions

Apr 21, 2020

Surge hospital at UNH Hamel Recreation Center
Credit Todd Selig

As cases of COVID-19 continue to rise in the Granite State, and questions remain about resources, safety, and the longevity of stay-at-home orders, we talk with state epidemiologists to get the latest recommendations and information about the coronavirus pandemic. 

Air date: Tuesday, April 21, 2020.


GUESTS:

  • Dr. Ben Chan - State epidemiologist for New Hampshire. 
  • Dr. Elizabeth Talbot - Infectious disease specialist at Dartmouth-Hitchcock Medical Center. 
  • Jason Moon - NHPR's healthcare reporter. 

Transcript

  This is machine generated transcript and may contain errors.

Laura Knoy:
From New Hampshire Public Radio, I'm Laura Knoy. and this is the Exchange.

Laura Knoy:
One of the most frustrating aspects of the coronavirus pandemic is that our understanding of it has been evolving and it's been hard for the public to keep up with advice on how to protect themselves and their families. And so today on the Exchange, we answer your questions as much as possible. We're talking with state epidemiologist Dr. Benjamin Chan and with deputy state epidemiologist Dr. Elizabeth Talbot. Also helping us out today will be my colleague, Jason Moon. He's NHPR's health reporter and Exchange listeners. As always, we welcome your questions.

Laura Knoy:
And Dr. Chan, like to start with you, please. What are the latest numbers that you have that tell us about the spread of COVID 19 in New Hampshire?

Dr. Ben Chan:
Yeah. So that the pandemic is continuing globally. You know, we're worldwide. We're up to almost 2.5 million cases in over seven hundred and eighty thousand cases in the United States. Um in New Hampshire, we're at one thousand four hundred and forty seven cases of COVID 19 people that have been confirmed with COVID 19 infection. What we've what we're seeing in the numbers is still consistent with what we've talked about the last week. The overall number of new cases every day that's being reported to us, is it stabilizing or plateauing, so to speak, the number of daily hospitalizations?

Dr. Ben Chan:
People that are hospitalized on a daily basis, for COVID 19, has been relatively stable the last couple of weeks. Our health care system has not reached what we call surge capacity.

Dr. Ben Chan:
And I think at this point where we're waiting and watching for the numbers to decline, that is I mean, where we're sitting around and that means we're you know, we're continuing our public health investigation, you know, isolating people, putting close to people who have been in close contact with someone, with COVID 19 on quarantine, trying to ramp up testing in our state.

Dr. Ben Chan:
We can be in a better position for when we start to reopen things around the state. But right now, it's important for people to continue with their social distancing measures because that's how we're gonna get these numbers to go back down.

Laura Knoy:
Well, and we talked about this a couple of weeks ago, Dr. Chan, in early April this week, and I remember you saying this this week was predicted to be the peak week for infections in New Hampshire. Do you think that will still be the case, given what you just told about the way the numbers are tracking?

Dr. Ben Chan:
Yeah, I think it very much depends on how how well and how strictly we adhere to the social distancing. Right. We've seen a plateau. So it certainly could be, you know, a peak that we're hitting here in the state. But there's still widespread. We believe widespread transmission of COVID 19 going on in the community. And so if we were to open things back up, you know, suddenly, rapidly, we would be at high risk for seeing the numbers go back up. And I think that that's that's the concern not only in New Hampshire, but around the United States. And that's why there's an ongoing discussion about how we can gradually and incrementally look health and things in the state, you know, closely following the numbers, monitoring, you know, transmission of COVID 19, so we can prevent any sort of rebound in terms of the numbers.

Laura Knoy:
Well, and again, you've talked about the importance of social distancing and how we are seeing evidence that it's working. How concerned are you, Dr. Chan, that this weekend, next, many school districts have decided to go ahead with April break so kids will be out. The weather is nice. Speaking as someone who has teenagers, it's going to be hard to keep those kids indoors or away from each other.

Dr. Ben Chan:
Yeah. You know, I think that's one of the that's one of the one of the challenges with the social distancing, staying at home, remote learning. We have tried to build social distancing into our daily lives. And the success of that is going to depend on people being willing and and complying with, you know, staying at home as much as possible. Understandably, it is important for people to be out and exercising and being active. We don't want people to be entirely isolated at home that has, you know, long term mental and emotional toll on people. So we encourage people to be outside walking, running. But it's important when they are outside to maintain a distance of at least six feet from other people that social distancing either try to stay home as much as possible and avoid unnecessary trips out. But we understand that the weather is getting nicer from people can and should be outside, but they need to maintain social distancing.

Laura Knoy:
Well, and Dr Talbot, those numbers that Dr. Chan gave us at the beginning of the show, how useful are these numbers for the public? Given that the vast majority of Granite Staters are not being tested?

Dr. Elizabeth Talbot:
It's a great point you're expressing our our own frustration and awareness that we have not tested everyone we want to test. Right. So there have been challenges at every step of the way toward getting a patient tested. You know, whether they don't have a primary care doc, whether their doctor's not willing to test, whether their doc has the supplies, whether there's a courier to take it, where the sample where it needs to go, etc.. So we are looking and working to increase testing so that everybody who needs it can get it.

Laura Knoy:
We got so many questions, as you can imagine, Dr. Talbot, from our listeners about testing here, too. And these came from our survey at NHPR dot org, where listeners have been sharing their stories and their questions. Ann from Manchester wrote us, why can't we start testing everyone on a regular basis. Ann says this is done in other countries, but we don't seem to be able to measure up in this country or in this state. There needs to be mass testing. And Elizabeth from Goffstown with a similar comment, she says, What is the basic problem with leading? To our inability to get adequate testing in place. And Dr. Talbot, to Elizabeth's point, what is our basic problem with this?

Dr. Elizabeth Talbot:
In the beginning, we didn't have the test kits, so the actual test that's used in the laboratory was a limitation that lasted way longer than we expected. This was a problem with the CDC test that we. Thought would come straight away and then it was delayed. And when it came, it had a dysfunction to it. So that was the first problem.

Dr. Elizabeth Talbot:
Then there was the issue of do we have enough swabs to actually take the sample? It seemed like such a trivial part of that. Right. Like, why not use a Q-Tip or whatever?

Dr. Elizabeth Talbot:
It's much more complicated than that, because the technology that's used to analyze the specimen is very sensitive to the components of that swab. So it has to be just right. And we continue to have issues with settings that are not really set up or equipped with the right personal protective equipment for their health care workers to take that specimen.

Dr. Elizabeth Talbot:
So, again, you know, we could go on and on, but I think the message is that we're going to get there. It's been a very slow, unexpectedly slow process. Ann and, Elizabeth, there are quite right that where we are below some other countries. But I would say a lot of other countries have had these troubles, too.

Laura Knoy:
Well. And how far did that set us back? Dr. Talbot? You know, we've heard from listeners who didn't feel well at the end of February, the end of March. They tried to get tested. Their doctor said, have you been in China? Have you know, have you been in Italy? And when people said no, they said okay you probably just have the flu. I'm just wondering how how much this set us back.

Dr. Elizabeth Talbot:
And it's a question that is going to be answered. I think that will we'll understand more about how lack of testing has allowed this virus to transmit. But I would offer it that if you were told by a doc that now we're not going to test you. We don't. We don't have the equipment. We don't. We don't think you you're in the right group. Whatever. And that you still should have stayed home. Right. I mean, so you still should have isolated. And so whether you had the test or not, we're hoping that that you adhere to the recommended self-isolation to prevent ongoing transmission. So that's something that's put in place as a redundancy to the ability to test and give a specific imperative to stay.

Laura Knoy:
Well, and I want to throw it now to my colleague Jason Moon for a lot more questions on testing.

Laura Knoy:
So, Jason, go ahead.

Jason Moon:
Thanks, Laura. Dr. Chan, what we've been aware of some of these testing challenges for a while, the issues with the CDC kits, the lack of testing supplies, reagents, the swabs and so forth. But those problems aren't unique to New Hampshire. And yet we have a lower testing rate than any of our neighbors, in fact, any other state in New England. New Hampshire is tested at, you know, proportional to our population, fewer people than any other state in New England. What do you think accounts for that? And and how much of a concern is that for you as an epidemiologist?

Dr. Ben Chan:
Yes. So I think there's several questions. And I think those are those are important questions. And, you know, first, I think it's important to you know, it's hard to compare New Hampshire to a state like Massachusetts or, you know, New York. Those who have, you know, more people and more health care resources, so to speak. But but, you know, I understand your question.

Dr. Ben Chan:
You know, we're also you know, New Hampshire is being compared to Vermont and Maine and other places. And so, as Dr. Talbot mentioned, we are absolutely aware of the need for increasing our testing capacity. And we're we're actively working towards that. You know, I think testing is important for a number of reasons. Testing is important that they can help inform the care of an individual. If we were able to go out and test everybody with, you know, symptoms, you know, testing would give us a more accurate number to know how widely COVID 19 is being transmitted. But one of the key roles for testing is its used in containing the spread of COVID 19. And what is going to stop or slow the outbreak where we are now? It is, I believe, primarily going to be for social distancing measures that are in place. Right. So we believe COVID, 19, is widespread in in our communities. We we and I don't think any state has the capacity to go out and test everybody that we believe might have cold symptoms or symptoms, even mild symptoms of COVID 19. And so that's the purpose of the social distancing.

Dr. Ben Chan:
Measures that have been put into place is to stop transmission between people, whether someone is tested or not. As Dr. Talbot mentioned, testing becomes critically more important as we see the numbers in our communities decline, as we see community transmission decline. And as we move from more of a community mitigation, social distancing stance to wanting to try and contain this virus more so that we can open things back up in our communities. And that is something that we and I know others in the state are actively working toward. So that we can dramatically ramp up testing. That is our goal. And that will be important, especially for when we begin to open things back up. But we are making efforts right now to increase testing. We have updated our guidance to health care providers just in the last week advising, you know, increased populations of people, the tests that we're working towards it. There are limitations we're trying to work through. And so I think people can expect to see increased testing and even increased numbers of people diagnosed with COVID 19 in the coming days as we work to test more.

Jason Moon:
Well, and just to follow up on that, maybe I'll turn it to you, Dr. Talbot. What is what are the factors that have gotten us to the point where we are now, where Vermont, for instance, is testing at twice the rate as New Hampshire.

Jason Moon:
Rhode Island is testing in more than three times the rate is. Is there is it a lack of of communication or awareness among providers about the correct protocols for who should get tested? Is it a particular shortage of testing supplies that is somehow only impacting New Hampshire? I'm just thinking a lot of listeners will be confused to hear that they're testing at twice the rate in. In neighboring Vermont. You know what is behind that?

Dr. Elizabeth Talbot:
I'm frankly not aware of the supply chain in Vermont or Maine, but I do know that we have very intentionally focused laser focus on the vulnerable populations in our state. We want limited testing to go to those people who need it most. So those are those who are in an institution such as a long term care facility, residential behavioral health, those settings where elderly are cared for or those who have complex medical problems. So we, I think, have been on very solid footing to direct our attention to those populations who are the most likely to need hospitalization, supportive care and even some of the novel treatments that are becoming available.

Jason Moon:
And I understand that today that many of the state's long term care workers are being tested across the states. That's an example of that targeted testing you're talking about. I do want to ask about another potential opportunity for targeted testing.

Jason Moon:
We saw that as of last Thursday, there were 426 first responders across the state quarantined because of possible exposure to the coronavirus. Are there any plans in the works to offer rapid testing for first responders so that they don't have to be quarantined for a couple of weeks, you know, unnecessarily if they don't have the virus? And as a as a quick follow to that, how many days after a potential exposure does a test become effective? If if an ambulance worker comes into contact with someone on Thursday who tests positive, will they know? How long do you have to wait before you test that ambulance worker?

Dr. Ben Chan:
So I'm not sure if that question was directed at Dr. Talbot or myself, but maybe I'll I'll take a first go at it. It's important to differentiate between testing people that are symptomatic, people with symptoms and people that are asymptomatic. Testing someone who has been exposed to the virus and is not having symptom is only helpful if that test is positive. Right.

Dr. Ben Chan:
If that test is negative, it doesn't mean that that person isn't going to go on to develop infection or might have just been exposed and that the test is not sensitive enough yet to pick up the virus because it hasn't had enough time to reproduce and replicate it in a person. So a test in an asymptomatic person or someone without symptoms is only is only helpful if that test is positive. So you know, anybody, whether it's the first responder or a health care worker or someone in the community, you know, a household member, if they have been exposed, someone with COVID 19, they are asked to quarantine regardless of whether they're tested or not, even if they were tested and test negative. If they were exposed to someone with COVID 19, they should still be under quarantine. Now, there are exceptions for people that are considered essential workers. That includes health care providers, you know, E.M.S. workers, that if someone was exposed, they can be allowed back to work under a certain precaution involving, you know, symptom and temperature monitoring. Every day a person has to wear a mask in case they, you know, if they develop symptoms, need to be sent home right away. So testing people that are asymptomatic does not necessarily change what they are asked to do. And in this day and age where we know that COVID 19 is spreading widely across the United States, that people can be spreading the virus even before they have symptoms. Everybody needs to be taking precautions and, you know, practicing social distancing, staying at home as much as possible for people that are health care workers or E.M.S. workers. The recommendation now is that, you know, people, especially if they're in a health care facility, should be should be wearing a mask to help mitigate this spread of the virus in the event that they might be spreading. It isn't dramatically.

Jason Moon:
So you're saying, then that if we were to test those 426 emergency responders and they all tested negative, it wouldn't necessarily mean that they the ones who were quarantined, would immediately be free to move back into the community as normal?

Correct. They would still be asked to operate under the same restriction that they were initially, even if they tested negative.

Laura Knoy:
A lot more questions about testing from our listeners and a lot of questions about immunity. Also just concerns about daily health and safety practices, masks, where and how to wear them and so on. We will talk about those after a short break.

Laura Knoy:
This is the Exchange, I'm Laura Knoy.. Today, the state's top medical officials address your questions and concerns about the coronavirus. We're talking with state epidemiologist Dr. Benjamin Chan and deputy state epidemiologist Dr. Elizabeth Talbot. Also asking questions today is NHPR health reporter Jason Moon. And all of you, we have received so many questions from our listeners about testing, about immunity. We will take as many as possible. For example, right now, let's talk to Bob in Concord. He's calling in. Hi, Bob. You're on the air. Welcome.

Caller:
Good morning.

Laura Knoy:
Morning.

Caller:
My question is for both doctors and I think and that is in the context of Vermont being what appears to be about 10 days past peak and New Hampshire looking like there's really two New Hampshires there's the very infected part in the south east corner. And then there's the rest of New Hampshire. When would you propose implementing a trace and quarantine? And why not create a two pronged strategy of dealing with the southeast corner differently? And then the rest of New Hampshire, which looks like they're they've got it under control?

Laura Knoy:
Well, Bob, great question and raises a lot of issues that are right at the forefront right now when people can start to emerge and the role of contact tracing in that. And Dr. Talbot, first of all, just explain to our listeners briefly what contact tracing is. That's a big issue now.

Dr. Elizabeth Talbot:
Sure. Happy to. That's something that we've been engaged in since day one.

Dr. Elizabeth Talbot:
So this has been a major effort for us to identify persons who first test positive. Or are those with compatible symptoms such that we believe they have disease, whether they tested positive or not. And there we ask them where they've been, who they've been in contact with in a significant way. And then those people are asked to be on quarantine to prevent ongoing transmission in the event that they should come down with the disease. So this is what we do. This is our active strategy. And we're going to continue to ramp it up because the example we have from other jurisdictions, from other countries, other states, is that That's the key to prevent ongoing transmission and propagation of the epidemic. Again, you've heard this is this is a terrible virus for the fact that it can transmit even before a person has symptoms. And that's why we've put so much effort into that. First of all, that contact tracing and subsequent quarantine. And second, the request that everyone wear a cloth mask when they're out in public, because that's what we call source control, preventing a person who doesn't even know that they're going to come down with disease and illness in 48 hours from contaminating the environment or, you know, inadvertently spreading it to those people that they are wandering within six feet just.

Laura Knoy:
Well, and you mentioned masks and we got a lot of questions about masks, for example, from Ben, who writes, If we've known that this is primarily a respiratory transmitted virus, why has the administration been so slow to adopt and enforce mace face masks for all civilians and workers and doctor channel? I'll throw that to you.

Dr. Ben Chan:
Oh, yeah. So I'm not I'm not sure what authority Ben is referring to, whether the federal authorities or state authorities.

Dr. Ben Chan:
You know, I think part of the difficulty with any new pathogen is learning about it and learning how it transmits and how easily it transmits.

Dr. Ben Chan:
And I think it's only in the last several weeks or months or so that we've really realized the extent that this virus can be spread and transmitted before someone develops symptoms.

Dr. Ben Chan:
And that has, you know, needing to learn about this virus in real time has made it difficult, I think, that to come up with strategies to control it. But given what we know now, you know, people who are out in public should be wearing cloth face coverings, given how easily this virus can transmit, it can transmit, given the fact that it can be transmitted, you know, days before someone develops symptom, a cloth face covering is a great idea. People are going to be out in public places to prevent that person from wearing the cloth face covering from potentially giving it to other people unknowingly.

Laura Knoy:
Well, I got a question from John in Amherst, who writes, I read that a face mask should be disinfected after each use. I also read that the longevity of coronavirus is up to three days. Does it, therefore, John asks, suffice to let a mask sit for four plus days between usage. John says I go out to shop for groceries about once every eight to 10 days, which is when I need my mask. And John, I'm so glad you wrote, because I think Dr. Chan, a lot of listeners have this. OK, I'll wear a mask when I go to the grocery store or the drugstore. It may not be perfect, but I'll wear it. And then you get back. I myself have had this question. What am I supposed to do with it when I get back, Dr. Chan?

Dr. Ben Chan:
Yes. And again, we're talking about cloth based coverings. So these should be washable. Right. So so certainly I believe that the person who asked the question was John. Certainly, John is right that, you know, the longer you let something sit the the less likely. If there are fomites, you know, infectious particles of the virus on there, that the less likely that those particles of virus are going to survive. But, you know, if someone's only going out to the grocery store once a week, you know, hopefully people are also routinely doing their laundry just, you know, throw the face covering in the washing machine.

Dr. Ben Chan:
That's that's how cloth, face masks or cloth face coverings should be managed. Ideally, they should be washed. They should be used daily and washed, you know, in between use every day. Understanding that not everybody does laundry every day. But if someone has multiple face coverings, they can, you know, alternate between them. But the general recommendation is to clean the cloth face covering the cloth face mask by using just a washing machine.

Laura Knoy:
And I have tried to watch most of the briefings from the governor and top state officials. You know, I haven't caught all of them. But the last one I watched, Dr. Chan, people didn't have masks on. The governor, You, head of HHS. When are you guys going to start wearing masks?

Dr. Ben Chan:
Yeah, great question, maybe Maybe we should. You know, I think that that's that that's a valid question. And again, I think that there are several things that go into transmitting the virus, you know, duration of time. Someone is in contact contact, you know, distance between people.

Dr. Ben Chan:
And so we when we hold these press meetings, there is an attempt to minimize con-, you know, close contact between people. And so if you'll notice at the meeting, we maintain at least 6 feet between people and that that should go a long ways to minimizing any any transmission between people.

Dr. Ben Chan:
But, you know, the other thing is that it's awfully difficult to talk sometimes through through a face cloth covering, you know, your off your nose and mouth. But, you know, the point point taken, you know, is something maybe we need to discuss more.

Laura Knoy:
Let's take another call. This is Sheila in Putney and Sheila. Go ahead. You're on the air. Welcome. Thanks for calling today.

Caller:
Can you hear me?

Laura Knoy:
I sure can, Sheila. Go ahead.

Caller:
Great.

Caller:
My question is about immunity. I thought I know some two people who were never tested, but they are quite sure that if they had COVID they had all the symptoms and. But they're recovered. They've been quarantined for a month and a half. And I heard on the radio the other day that it is possible that you can be. You can recover. You can have the antibodies in your system and still be a carrier. Still be contagious. Can you comment on that, please? I've heard that plus things opposite to that.

Laura Knoy:
Sheila, I'm so glad that you called. And I want to let you know that another listener also had the exact same question. If you've had COVID 19, Ellen from Sullivan wrote, and you're recovered, are you immune? And Ellen in Sullivan also wanted to know if I've had the virus, if I'm immune. Can I still give it to other people? So thank you, Sheila, for calling in. Dr. Talbot, can you take that one, please?

Dr. Elizabeth Talbot:
I can try we're again watching data emerge from settings where they they're ahead of us. You know, so. So in some of the Asian countries that have experienced the epidemic earlier, there is the phenomenon where somebody even tests positive.

Dr. Elizabeth Talbot:
And if you serially test them with the PCR, the routine test that's used here, you can see that the virus is detectable even out to 20 days, but that it's bits and pieces. It's not sure that that material is detected as something that could infect others. That's not been shown yet. We also have the phenomenon where somebody is confirmed with disease and they're tested serially. They go negative and then they go positive again.

Laura Knoy:
Oh, dear.

Dr. Elizabeth Talbot:
Right. So I don't mean to raise any concerns there, but the issue lightly there is that the test just wasn't able to detect a small amount of viral particle. And then the next time, maybe the sample was a little bit better and there was more virus bits left and that was testable. We don't know what these things mean with regards to an ability to transmit to others. So we're taking the most conservative precautions with regards to recommending isolation after disease, whether proven or suspected. And we go we're even more careful about that when it comes to health care workers and people who are working and sometimes among vulnerable persons. So a lot to learn. Yeah. But but those are some of the new features that this virus is presenting to us.

Laura Knoy:
So, Dr. Talbot, just to be clear, having COVID 19, clearly confirmed, you know, recovering from that illness is not a get out of jail free card.

Dr. Elizabeth Talbot:
We have criteria to correlate with infectivity. That is what we would advise that a person who is confirmed or suspected with disease remain on isolation for seven days after the first symptom. And also, at least three days has passed since the onset of some recovery, including lack of fever. So those are the criteria that we are adhering to and as believed, work well, go ahead.

Laura Knoy:
Yeah, I guess what I'm trying to ask is by that get out of jail free card and maybe that wasn't well phrased. What I'm trying to ask is if I had COVID 19, if I recovered. Am I good from here on out? Like I'm not going to get it again and I'm not going infect, my family.

Dr. Elizabeth Talbot:
Oh, yeah. Great point. So we believe that when you have disease, when, you know, confirmed or not, that that you are likely immune. That's the word that's been used by Sheila and others. You likely are not susceptible to getting it again or transmitting to others.

Laura Knoy:
Oh, Sheila. Yeah, no. There's a lot still to be discovered there for sure. And Sheila I really appreciate the call. And also all the people who wrote in their questions, including Ellen on that one. And Jason Moon, I'm going to throw back to you. I know you've more questions around this topic of like when people can get back out and get back to possibly a little bit of normal life.

Jason Moon:
I do. Dr. Talbot, if I could just follow up on a couple of things you said there. One is getting back to earlier when you were talking about contact tracing and how obviously that's been something that public health officials in New Hampshire have been doing since the beginning. And it was it was arguably more of a focus sort of in those earlier days than it is now. But it does seem now that we're beginning to have the discussion about reopening that contact tracing. Will will again be a really important part of the overall approach here. My question is, how many people do we currently have in in public health doing contact tracing? And are there you know, do we have enough and are there plans to hire more? We just saw in Massachusetts, they just hired, you know, a thousand new contact tracers to to be really aggressive about doing those tracings. Do we have any similar plans here in New Hampshire?

Dr. Elizabeth Talbot:
A couple of things on that Jason, and I'm surprised to hear you say that it was more of a focus at the beginning, and I want to correct that, that we have been full court press on this since the beginning. We've not let up on our contact tracing at all. So we do believe we'll need to put more attention to it. You know that when when we decide that it's appropriate, when the governor decides it's appropriate to. Release some of the suggested social distancing enclosures. We will even accelerate that and probably would need more, more staff. But I'll leave staffing issues to the administration.

Jason Moon:
And I should say that the issue of focus. I was speaking more from the public or perhaps from my own perspective, not in terms of what what you folks are doing, but could. Do you have a sense of how many contact tracers are working right now?

Dr. Ben Chan:
Yeah. So if I can if I can jump in, I'm sure, you know, there's multiple lines of work here, if you will.

Dr. Ben Chan:
There's people that are doing the investigations and the and the contact tracing. There's people that are doing the monitoring of people that we know are on isolation and quarantine. And I think in our infectious disease group as a whole, there's probably around 70 or so individuals that are actively doing a lot of this work. And there's efforts being made to bring on more staff and more capacity. You know, increasing staffing by, you know, at least 50 to 70 percent, you know, potentially in the coming in the coming days. So this is something that I think all health departments around the country are looking at doing, especially as we see the numbers across the country begin to plateau or peak. And there won't be a need for not only increased testing, but, you know, increased testing is really only helpful if we can follow up those tests with the public health contact tracing that is being discussed.

Dr. Ben Chan:
So there's a general recognized need to connect that testing with increased ability to do to do the investigation. And that is occurring in New Hampshire and that's occurring, you know, in states around the country.

Jason Moon:
Yeah. And if I could just drill down that for a second, that that 50 to 70 percent increase in in public health workers, contact tracers, that's that's in the works that's that's happening now. How how sort of how real is that.

Dr. Ben Chan:
Yeah. That that's a that's that's in the works right now. You know, I can't I can't speak to, you know, exact numbers on on when exact people will be brought on. But that that is something that we have continually monitored and have ongoing efforts to make sure that we are staffed appropriately and have the ability to increase that if and when it's needed.

Jason Moon:
Ok. And then Dr. Chen, maybe I'll I'll turn you on this one. Earlier we were the discussion about whether a test is this sort of be all end all for someone's relationship to COVID 19. What about. I think this sort of big fear that that a lot of people might have is is false negatives. You know, what? Do we know anything about the rate at which false negatives are are occurring? Someone gets a test for COVID 19. This test says they don't have it, but the test is wrong. Is there a percentage that we know of at this point of tests that are coming back falsely negative?

Dr. Ben Chan:
So any time you roll out a test, you need to compare it to something. What's the gold standard of diagnosing disease? And right now, you know, from what we know about these tests are that they are very sensitive for picking up replicating or not even necessarily replicating virus for picking up virus in the upper respiratory tract. There has been a lot of talk about high false negative rates with this test. And honestly, I have not seen much data to support this. I think a lot of this is coming from anecdotal reports from outbreaks in other countries. Clinicians have that have seen patients that, you know, in outbreak settings that they're concerned have COVID 19 but people test positive. Right. We're getting these same reports here in New Hampshire. But I think it's important to keep in mind that there are many things that cause the same kind of symptoms and clinical picture that COVID 19 can cause. And so there has been this message that this communication going around, you know, that these tests are not sensitive at picking up infection. And we believe that they are they they should be by by the nature of the tests, very sensitive at picking up virus in the upper respiratory tract.

Dr. Ben Chan:
Certainly no test is 100 percent perfect, so there's always going to be the possibility that someone could test negative, you know, and and still have the infection, but we don't have a lot of evidence that this is occurring commonly.

Laura Knoy:
Well, coming up, a couple more questions from our listeners about quarantine and more questions about when and how and what might be needed before people could start to again emerge from their stay at home orders.

Laura Knoy:
This is the Exchange, I'm Laura Knoy. This hour, the state's two top public health doctors are with us to answer your questions. And our guests are state epidemiologist Dr. Benjamin Chan, deputy state epidemiologist Dr. Elizabeth Talbot, who's also an infectious disease specialist at Dartmouth-Hitchcock Medical Center. And helping us out with questions today, too, is NHPR's health reporter, Jason Moon. A couple more questions for you, not throw this to you, Dr. Talbot. We have received many questions about grocery products with listeners asking should they wipe down every milk carton and cereal box when they get home? We talk to grocery store leaders last week. They said no, but we still continue to get these questions. So, Dr. Talbot, what are you doing when you get home from the grocery store?

Dr. Elizabeth Talbot:
I am not wiping everything down.

Laura Knoy:
You're not?

Dr. Elizabeth Talbot:
No. We approach this with humility, right. We don't know everything we want to know. We know that there have been some fairly carefully controlled studies where they take virus and place it under extremely controlled circumstances on different kinds of surfaces and see how long they can recover it. And indeed, as one of our previous question submitters said, there can be hours and even days under these strict laboratory conditions where every feature is controlled. That's not life on planet Earth. That's not what happens on a carton of milk in the grocery store. You know, these are subject to the temperature and the handling only by very few people. So we keep stepping back to what we do know about this virus, and that is that we can prevent environmental contamination by adopting the universal masking, this cloth face mask covering. That's what we're doing with that. We're trying to prevent environmental contamination and that includes grocery.

Laura Knoy:
Well, a similar question about contamination. Dr. Talbot came in from Jamila in Portsmouth, who writes. How likely is coronavirus carried on clothing? And we have heard from health care workers and grocery workers who tell us they're shedding all their clothes as soon as they get home, immediately putting them in the wash. What about that, Dr. Talbot?

Dr. Elizabeth Talbot:
I'm not aware of a single case that's been transmitted by clothing contamination. I think that people are right to be careful with the recognition that there can be virus contaminating environment, especially commonly touched surfaces like doorknobs and handrails and grocery cart handles, et cetera. But I'm just not aware of that. That as a mechanism of transmission.

Laura Knoy:
All right. And Jason, I'll throw back to you. Go ahead, please.

Jason Moon:
Thank you. Dr. Chan just returned to the topic of testing yet again, based on the data that the state has been sharing with with the public for about the past month. We've been averaging about 450 tests a day for people in New Hampshire. That's commercial labs, that's through the state lab, through Dartmouth-Hitchcock Medical Center's in-house test. What is there a number at which you you feel like we need to be getting to tests per day to to be more confident in making decisions about reopening? You know, is it 1000 tests a day? Is it. Is it 2000 is a 10000? Is that a number you you watch?

Dr. Ben Chan:
Good. Good question. And I think there's a couple there's a couple questions in that. The ability to or the re-opening things. I don't think is dependent on our ability to be to be doing a certain number of tests. Right. That the ability to start reopening, I think, is dependent on what the evidence of community transmission showed. So once we had evidence of the things decreasing community transmission, regardless of the number of tests that are being performed, then I think there is the it is when there needs to be consideration for it for opening, you know, slowly and gradually, incrementally opening things in our society.

Jason Moon:
But just a jump in here, wouldn't wouldn't your confidence in the fact that it is beginning to taper or slow increase if there was more testing. Right. You'd be more confident that that the curve is actually going downwards based on a larger sample size, wouldn't you?

Dr. Ben Chan:
Yes. So so I think I think that testing can help inform that. Certainly, I don't mean to imply otherwise. But we also have other data, hospitalization numbers, outbreaks. You know, the number and then the outbreak at facilities.

Dr. Ben Chan:
We have community tracking of health care and E.R. emergency room visits or people going in for influenza like illnesses. Right. All of these data points need to be taken into consideration when I think deciding when is an appropriate time to start reopening things. Testing becomes much critically important for trying to move from a community mitigation to a containment standpoint.

Dr. Ben Chan:
And so our goal should be not, I think, and again this is my own personal perspective on this. Isn't necessarily a set number of tests as opposed to really being able to go out and test anybody with COVID 19 symptoms. Right.

Dr. Ben Chan:
And that is a goal that we're working towards. We want to increase testing capacity now. As we increase testing capacity now, we're going to see an increase in numbers because as we test more, we're going to detect more. But the ultimate, you know.

Dr. Ben Chan:
Trigger point, if you will, for when. When to start reopening. I think it's going to come down to sort of broader numbers and data on evidence of community transmission and not simply on how many people we can test. We need to be able to test more because that's going to impact how quickly and how rapidly and how competently we can we can reopen things. We're working towards that. But there are many different factors involved in this decision about when when things can be reopened.

Jason Moon:
Thanks, Dr. Chan, Dr. Talbot. To you. There are some in New Hampshire who who would like to reopen much sooner than perhaps is the general sentiment. Just this past weekend, there was a rally, a demonstration on the statehouse lawn of, I would say well over 100 people, you know, calling on the governor and the legislature to remove some of these restrictions and reopen the economy. And, you know, along with along with arguments about individual liberty and and constitutional arguments, they also made a a public health argument that I would like to get your response to, and that the argument was that there are serious negative public health consequences to a recession, that if a lot of people lose their jobs, we have a really high unemployment rate, that that will lead to increases in suicide and in substance misuse disorders, and that that could ultimately end up doing more harm than the coronavirus pandemic. That was that was one of the arguments sort of on display on Saturday. How would you respond to that as a as an epidemiologist?

Dr. Elizabeth Talbot:
I think that it's certainly understandable that people are wanting to get back to their routine life and also to recover the economy. This story will be told over months and years. What the risk and cost and benefit have been of the actions taken. I certainly don't want us to lose sight of the fact that the current plateau we're seeing is a result of these efforts. And when they are loosened, it's likely that there can be rebound. So these are extremely complex equations to come to the right cost to our society for. For these interventions. I'm certainly working toward protecting those who are most vulnerable. So those who are most likely to die from this disease need to be protected. And my.

Laura Knoy:
Well, let's take another call from our listeners. And Chris is in Epping calling in. Hi, Chris. Good. You're on the air. Thank you for being with us today.

Caller:
Hi Laura. Thank you. I've heard a lot about wastewater testing. I heard about it a couple of weeks ago, but not much since there was a company called bio bot out of M.I.T which was able to detect COVID 19 in wastewater and also estimate the prevalence of the infection in the community. And with all this talk about securing new swabbing tests and a containment approach, what I'm wondering is why aren't we hearing more about augmenting that type of testing with wastewater testing and using it as an early detection system?

Laura Knoy:
So, Chris, sort of as a community read, not an individual read, but a community read, how much COVID is there in the wastewater and what does that tell us about the community? Is that what you're saying?

Caller:
Yes. The articles that I've read have said that it can be used as an early detection system, that you can you can see what the prevalence does. prevalence is of COVID 19 in the community. And if you see a spike from wastewater testing what you can then do is isolate that community quarantine response and follow up with traditional testing and do contact tracing.

Caller:
But it can be used as an early detection system that seems like it could really augment, you know, the traditional testing for lack of a better way to say.

Laura Knoy:
Sure the person to person.

Caller:
So you don't have a lot of we don't have enough of those types of tests.

Laura Knoy:
That's interesting. Chris, thank you for calling. And Dr. Chan, I've not heard of this, but we have done earlier shows on just trace amounts of pharmaceuticals showing up in water supplies before they are treated. Have you heard anything about this? Dr. Chan COVID 19 testing in community wastewater.

Dr. Ben Chan:
Yeah. So. So Chris is right that there have been. I'm aware of one other place that went out and more in the realm of research, you know, tested wastewater to see if they could find it. You know, I think what what finding what it means to find virus in wastewater. You know, I'm not sure how that would be actionable from a community or a public health standpoint. You know, I think it's a good question. You know, can can it give us some information? And I think we know that COVID 19 is in our communities and it's widespread. And we expect it to be if we were to go out and test wastewater, we would expect COVID 19, you know, to be detected, again, the genetic material to be detected. But it wouldn't necessarily change what we do. Right.

Dr. Ben Chan:
We're already doing contact tracing and public health investigation. We're already trying to ramp up testing of people that are sick and symptomatic. We're already trying to protect our health care system and the vulnerable people that live in Long-Term Care Facilities.

Dr. Ben Chan:
So, you know, I don't think it's something that has one been well validated or studied. And. And I don't think it would change what we're doing currently because we believe organizing is widespread in our communities.

Laura Knoy:
Well, Chris, thank you for the call. And Andy wrote us an email. Can anyone say what will happen when the test results from health care facilities come back with positive results? Andy asks, Is there a secret population of health care workers ready to take over? Andy, excellent question. And Dr. Talbot, I know this is something that, you know, doctors' offices, hospital systems, nursing homes have been worried about. That as more of their workers get sick and have to stay home. Who's going to take over?

Dr. Elizabeth Talbot:
So there are many strategies emerging for crisis standards of care. So ways to continue to deliver vital health care, even if health care workers are disproportionately impacted by this virus or whatever is next. So even now, we are implementing the most careful of strategies to allow certain essential personnel to return to work under controlled circumstances. And we're also exploring strategies to bring health care workers back into the health force or early into the health force. So it's something that we've been planning for for a very long time, even before COVID 19 showed its ugly face.

Laura Knoy:
Well, in a related question came in from Peggy in Hollis, who says, If a nurse or other health care professional comes to New Hampshire from another state to provide relief to staff, does that nurse need to self-quarantine for 14 days before he or she can begin to work at the New Hampshire facility? Are they tested at the New Hampshire facility? This is a great question to Peggy. Thank you for writing in. And Dr. Talbot, go ahead.

Dr. Elizabeth Talbot:
So we're in universal masking in health care facilities for the purpose of avoiding shedding for somebody who is before symptoms. And we're also requiring screening at the entrance of every health facility for staff and visitors alike. Patients alike to make sure that nobody is minimally symptomatic or early in the course of their disease. So there are redundant strategies to prevent introduction of disease into our health care facilities.

Laura Knoy:
So that nurse would not have to self-quarantine for 14 days.

Laura Knoy:
If he or she came to New Hampshire to help out.

Dr. Elizabeth Talbot:
No. When there's a need for a healthcare worker in a setting response that favors having that person work under very controlled observed circumstance. That's right.

Laura Knoy:
Well, last questions for both of you. And again, you've been really generous with your time. We appreciate it. And Dr. Chan, what is the one question that you're getting over and over that regular people, you know, like me, like Jason Moon, who aren't medical experts, just seem to have a hard time understanding. Why do you keep hearing Dr. Chan again and again from folks?

Dr. Ben Chan:
Yes, I think I think I think it's a great question. And I think there's a lot of we're still learning about this virus. So I think understandably, there's a lot of questions and concern that even confusion, the one the one question that keeps coming up.

Dr. Ben Chan:
I think it's similar to the questions that have been asked on on this on the show around when we can reopen and and testing. So how testing relates to reopening. And I would repeat again that again, we want to increase testing capacity as much as possible. Testing will help inform the spread of COVID 19 in our community. But testing becomes critically important when we start to reopen things back up so that we can respond to clusters of infection that pop up and go more from a mitigation mode. Social distancing mode to containment mode, trying to stamp out infection, if you will, before it can spread. That's that that's where testing becomes critically important when we can start to reopen things back up. I think is a question that's still being discussed and debated not only in New Hampshire, but across the country. And I want to take a safe but proactive approach to that. And we need to do it based on, you know, data and being informed by our capacity to undertake these important public health steps of testing and contact tracing.

Laura Knoy:
Well, we really appreciate you being with us today. And again, we had a lot more questions from our listeners, so I'm sure we'll talk again soon. Dr. Chan, thank you very much for being with us. I appreciate it.

Dr. Ben Chan:
My pleasure. Thank you.

Laura Knoy:
That's state epidemiologist Dr. Benjamin Chen and Dr. Talbot, thank you also for your time.

Dr. Elizabeth Talbot:
Thank you for having me, Laura.

Laura Knoy:
That's Dr. Elizabeth Talbot. She's also an infectious disease specialist at Dartmouth Hitchcock Medical Center, as well as the deputy state epidemiologist. And Jason Moon was great having your help. Thank you very much for taking the time.

Jason Moon:
Always happy to do it. Laura.

Laura Knoy:
That's Jason Moon NHPR's health reporter. The Exchange is a production of New Hampshire Public Radio.